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Nigeria: Assessing impact of PTF interventions on health sector

by Haruna Gimba
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By Racheal Abujah

Some health experts argued that the COVID-19 pandemic has rewritten some public health rules in Nigeria. They opined that the country’s health facilities and medical equipment especially in the rural areas, were not adequate to curtail the spread of the virus.

They recalled that the country had battled several outbreaks including Ebola, Lassa fever, cholera, monkey pox, among others.

They also noted that spending on the country health security has not matched its policies.

After the outbreak of the pandemic, several measures were put in place, including the setting up of the Presidential Taskforce on COVID-19, on March 9, 2020 by President Muhammadu Buhari.

The PTF, headed by Mr Boss Mustapha, the Secretary to the Government of the Federation, was mandated to provide overall policy direction, guidance and continuous support to the National Emergency Operations Centre (EOC) at the Nigeria Centre for Disease Control (NCDC).

The PTF was also saddled with the responsibility to provide policy direction to ministries and government agencies involved in response activities to enable them devise and implement a National Response Strategy.

The COVID-19 pandemic posed a great challenge because Nigeria has very few molecular laboratories to conduct tests.

To redress the situation, the PTF embarked on massive establishment of laboratories for testing and commenced the use of GeneXpert across the country to scale-up testing.

Before the pandemic, the country had just five molecular laboratories that could scale for a virus like COVID-19.

But as a result of the pandemic, 140 new laboratories were built and inaugurated across the country, as at July 2021.

Now every state has at least one public health laboratory with molecular testing capacity.

Before the first confirmed case in Nigeria, the country had started preparation with support from international donors. The PTF started working with states and hospitals to map out and establish isolation and treatment centres for the management of the virus.

In addition, health workers were trained on case management, infection prevention control, surveillance, risk communication and other areas of epidemic preparedness and response.

Through the Private Sector Coalition Against COVID-19 (CACOVID), each state was to receive a 30-bed ICU centre for critical care. President Buhari also approved the construction of one oxygen plant in each state of the federation and the FCT.

In March 2021, the Presidential Steering Committee (PSC) was rebranded to enable it push further coordination of the vaccine rollout, deployment and administration, while a private sector supported transition consultant sustains the multi-sectoral relations and policy guidance.

The PSC said that acquisition of sufficient doses would enable the country vaccinate 70 per cent of its population, that process is still in progress.

However, some health experts say irrespective of the interventions, health care service delivery in the country is still poor and remains a huge source of concern.

They noted that while the interventions of the PTF had improved quality of care and response in the public hospitals, the situation is far from ideal.

This may have prompted President Buhari to raise the Health Sector Reform Committee for the development and implementation of a Health Sector Reform Programme for Nigeria.

The Chairman, Ministerial Expert Advisory Committee on COVID-19 Response, Prof. Oyewale Tomori, while commending the PTF, said that the task force input in the heath sector could be described as a temporary blessing that may become a long-term blight, if not built upon.

“Our response to COVID-19 outbreak has shown again, that we are a nation that makes weapons of war at the battle front, a nation that pours icing on a rotten cake, pouring a rain of money on a flooded and floundered health system,” he said.

Tomori noted that the COVID-19 pandemic has exposed the weaknesses in the health system.

He said that as usual, the government had thrown a lot of money at the problem, mostly, ineffectively used, leading to an uncoordinated and hardly effective solution.

“We often forget that money alone cannot solve all problems. The motive behind, and the character in spending the money, define the success of the input.

“It is not throwing money into a problem; it’s how we use that money. As a result of the COVID-19 pandemic, more money was channelled into the health sector through different routes – more labs are now in place, a few additional isolation wards here and there etc.

“In 2020, when COVID-19 arrived, Nigeria could only boast of two or three labs with capability and capacity for COVID-19 diagnosis, but now we have 140 labs distributed all over our 36 states, plus the FCT,” he added.

He, however, questioned how effectively the labs were used. “Only 13 or fewer states testing and reporting results, regularly and timely. One wonders why we even bothered to set up those labs, if they end up being useless and incapable of performing the assignments of intended purpose.

“What were the real motives for setting up those labs – opportunity for dubious contracts or phony procurement?

“Another issue is the quality and reliability of the results from some of the labs. Currently, we receive a lot of reports of tests done on Nigerians who travelled abroad. They leave Nigeria with negative COVID-19 results and overnight on arrival at their destinations outside Nigeria, the results done on those same Nigerians turn out positive,” he noted.

Tomori wondered if there is a problem with the labs, or the quality control and monitoring systems were incapacitated, and unable to detect fake results at the ports of departure.

“Whatever the reason, Nigeria and Nigerians are the losers, as many countries will stop accepting results from our labs,” he reasoned.

“Our response to the COVID-19 outbreak should have been an opportunity to address other healthcare related issues, but we missed the boat,” he further noted.

Health Economist, Dr Abigail Banji, thinks that the COVID-19 pandemic has brought into sharp focus the need for health care reforms that promote universal access to affordable care in Nigeria.

Banji predicts that health care in the country will face incredible challenges in the coming years, given the way the country’s healthcare system was unravelling in the time of crisis, leaving millions of Nigerians vulnerable.

She is advocating a swift, coordinated political action to ensure access to affordable care for all even as she noted that overall, the PTF has responded to COVID-19 swiftly.

“At the start of the outbreak, the PTF worked with technology and the media to promote accurate information. It coined the phrase `infodemic’ to describe the rapid spread of misinformation about the new virus.

“Beyond pandemics, the work of promoting science-based policy, strengthening health systems and expanding access to care is not glamorous.

“But it is vital. The country’s record on COVID -19 is still far from perfect, the possibility of a pandemic on such a scale is still possible.

“An illness caused by a pathogen never seen before in humans that would cause the next pandemic and wreak havoc. Is Nigeria now prepared for the next pandemic? This is what the PSC should strongly look into,” she advised.

The health economist stressed that the country may need to investigate outbreaks more independently and to establish a system so that it can issue warnings about public-health emergencies earlier, rather than waiting for the international health organisations.

“A year ago, the risks of a weak health system in the country was hard to calculate. Today, the costs of failure are measured in trillions of naira and the loss so far of over 2,500 lives to COVID-19. Our policies on health care, both during this pandemic and in the future, should reflect this reality, and we should not let the lessons of this crisis pass us by,” she added.

But Dr Walter Kazadi Mulombo, the WHO representative in Nigeria, described the PTF as a game changer in the fight against the pandemic in the country. “The fact is that Nigeria was among the first to confirm the coronavirus case in the region, the PTF played a role in curtailing the magnitude of the pandemic in the country.

“The PTF was a platform to discuss health across sectors and not just health as an issue for one ministry, Ministry of Health. We have several ministries playing a part, this was what helped the country,” he explained.

“The PTF was able to engage the CACOVID, and the non-state actors to take action. So, this has given an opportunity for a deeper reflection in the way things were being done.

“I could see a huge difference in the way the states for example were managing outbreak and other emergencies. So, I think it’s a direct impact of high-level leadership, because everything starts with a political commitment and the PTF has greater political commitment that was strong,” he noted.

Mulombo said that through the PTF, the country’s laboratory capacity was developed, which makes the country better prepared ahead of any emerging disease. (NANFeatures)

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